多囊卵巢综合征子宫内膜甾体激素受体表达与临床特征研究

目的检测多囊卵巢综合征(PCOS)患者子宫内膜雌激素α、β受体(ERα、β)、孕激素受体(PR)、雄激素受体(AR)的表达,探讨其与PCOS患者性激素、血脂、胰岛素抵抗指数(HOMA)、体重指数(BMI)等临床特征的关系。方法选取PCOS患者31例作为实验组,输卵管性不孕患者20例作为对照组。对比PCOS患者与对照组年龄、BMI、血脂、性激素、HOMA和子宫内膜甾体激素受体表达情况。且PCOS患者按照肥胖与否、胰岛素抵抗正常与否和睾酮高低分组。采用免疫组化方法检测各组子宫内膜ERα、ERβ、PR、AR表达。通过相关性分析PCOS组子宫内膜ERα、ERβ、PR、AR与血清雌激素水平的关系。结果 PCOS组和对照组年龄、BMI、血脂差异无统计学意义;PCOS组睾酮、雌激素、HOMA-IR高于对照组。PCOS组子宫内膜腺体及间质的ERα、ERβ、PR、AR表达均高于对照组;但两组的ERα/ERβ表达差异无统计学意义。PCOS高睾酮组与正常睾酮组除AR外其余各甾体激素受体在子宫内膜腺体和间质的表达均差异无统计学意义;PCOS高睾酮组腺体AR表达高于正常睾酮组。高睾酮组ERα、ERβ、PR、AR表达高于对照组;正常睾酮组ERα、PR、AR在腺体和间质的表达及腺体ERβ表达高于对照组。PCOS肥胖组和非肥胖组ERα、ERβ、PR、AR在子宫内膜腺体及间质中的表达均高于对照组。但肥胖组与非肥胖组ERα、ERβ、ERα/ERβ、PR、AR表达差异无统计学意义。PCOS胰岛素抵抗组与非胰岛素抵抗组ERα、ERβ、ERα/ERβ、PR、AR表达差异无统计学意义。胰岛素抵抗组ERα、ERβ、PR、AR、腺体ERα/ERβ表达高于对照组。非胰岛素抵抗ERα、PR、AR、腺体ERβ表达高于对照组。相关性分析发现PCOS组子宫内膜间质ERα、PR、ERα/ERβ表达与血清雌激素水平呈正相关;腺体ERα/ERβ、AR、PR表达与血清雌激素水平呈正相关。腺体ERβ的表达与血清雌激素水平呈负相关。腺体AR表达与血脂中的胆固醇(CHO)、高密度脂蛋白(HDL)、载脂蛋白B(APO-B)水平呈正相关。结论 PCOS患者子宫内膜甾体激素受体表达高于正常妇女,除ERβ外其他甾体激素受体表达与PCOS血清雌激素水平呈正相关,ERβ与雌激素水平呈负相关。高雄激素血症、高脂血症可以增强PCOS患者子宫内膜AR表达。

Study of the relationship between steroid receptors in endometria and clinical features with polycystic ovary syndrome

Objective To evaluate the expression of steroid receptors（ estrogen receptor α,estrogen receptor β,progesterone receptor, androgen receptor,ERα,ERβ,PR,AR）,in endometria of polycystic ovary syndrome（ PCOS）. To study the correlation between the the expres-sion of steroid receptors in the endometria and the clinical features of polycystic ovary syndrome. Methods Case-control study was used to 31 pa-tients with PCOS and 20 healthy women . Immunohistochemistry was used in expression studies of ERα,ERβ,PR,AR. Insulin and glucose lev-els of serum（ OGTT,INS）were measured using RIA and glucose oxidase test,respectively. A fasting blood sample was drawn for plasma hormone profile ,lipid and lipoprotein profile. Results The expression of ERα、ERβ、PR、AR in the endometria of PCOS was higher than in the control group. The expression of AR was higher in PCOS with hyperandrogenemia than in PCOS with normal androgenemia and control group. The expres-sion of AR was higher in PCOS with hyperandrogenemia than in PCOS with normal androgenemia and control group. The expression of ERα,ERβ, PR,AR was higher in PCOS with hyperandrogenemia than in PCOS with control group. The expression of ERα、PR、AR and ERβin intercellular substance was higher in PCOS with low testosterone levels than control group. The expression of ERα、ERβ、PR、AR was higher in obese and not obese PCOS with than control group. But,the expression of ERα,ERβ,PR,AR in the obese and not obese PCOS was no difference. The expres-sion of ERα、ERβ、PR、AR was higher in obese and not obese PCOS with than control group. But,the expression of ERα,ERβ,ERα/ERβ,PR, AR in the hyperinsulinemia and non-insulin resistance PCOS was no difference. The expression of ERα,ERβ,PR,AR and ERα/ERβin gland was higher in PCOS with non-insulin resistance PCOS than control group. Hyperinsulinemia and obesity were not associated with expression of ERα,ERβ,PR,AR. Person correlation analyze found plasma estradiol（E2）level was related with ERα?